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Glycaemic control in diabetic nephropathy.

J J Bending, J C Pickup, G C Viberti

    British Medical Journal (Clinical Research Ed.)
    |April 21, 1984
    PubMed
    Summary

    Diabetic patients with proteinuria have worse daytime blood sugar control on continuous insulin infusion compared to those without proteinuria. This may hinder intensified insulin therapy effectiveness in diabetic kidney disease.

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    Area of Science:

    • Nephrology
    • Endocrinology
    • Metabolic Diseases

    Background:

    • Persistent proteinuria and declining renal function are complications in diabetic patients.
    • Effective glycaemic control is crucial for managing diabetic nephropathy progression.

    Purpose of the Study:

    • To compare glycaemic control in diabetic patients with persistent proteinuria and declining renal function under different insulin regimens.
    • To investigate the impact of proteinuria on glycaemic control during continuous subcutaneous insulin infusion.

    Main Methods:

    • A matched-group study design was employed.
    • Three groups were studied: diabetics with proteinuria on continuous subcutaneous insulin infusion (CSII), diabetics without proteinuria on CSII, and diabetics with proteinuria on conventional insulin treatment.

    Main Results:

    • Diabetics with proteinuria on CSII exhibited poorer daytime glycaemic control than those without proteinuria on CSII.
    • However, glycaemic control was significantly better with CSII compared to conventional insulin treatment in patients with proteinuria.
    • Reduced prandial insulin dosing due to daytime hypoglycaemia likely contributed to poorer control in the proteinuria group on CSII.

    Conclusions:

    • Proteinuria negatively impacts daytime glycaemic control in diabetic patients on CSII.
    • Suboptimal blood glucose management may limit the benefits of intensified insulin regimens on diabetic renal disease progression.

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